German Measles ( Rubella )

Rubella, also known as 'German measles' or the 'three-day measles', is caused by the rubella virus. Compared to the red measles caused by the rubeola virus, rubella is a milder ailment that basically infects the skin and the lymph modes. Generally, the disease is spread by means of nasal droplets or precipitations from the throat. People develop this disease when they inhale these droplets from the victims.

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Precisely speaking, the ailment is transmitted through the respiratory means. What is worse is that people who are already infected by rubella virus carry it in their respiratory tract prior to actually falling sick. In fact, it is possible for such people to transmit the ailment even having no knowledge that they have already been infected. The malady is also transmitted via a pregnant woman's bloodstream to infect the fetus. In fact, the rubella has the potential to result in major birth defects when this happens.

As mentioned earlier, when children develop rubella, it is usually an insignificant ailment. However, when the infection is transmitted from a pregnant woman to the fetus, it may result in congenital rubella syndrome (CRS) causing serious harms to the still-born babies.

Rubella or German measles is a very familiar ailment among children and is marked by common malaise (a vague feeling of physical discomfort), rash and swollen lymph glands. Normally, the lymph glands are affected first and they become swollen. Subsequently a rash appears on the face and back and gradually extends to the trunk and the terminal points of the hands and legs. The rash remains on the body for approximately three to five days and usually the gashes that have appeared first are also the first to be healed. The rashes are raised and resemble pimples and are reddish or pink in appearance. Other symptoms of the illness may also include sore and swollen joints in affected children. Although the throats of the patients may appear to be reddish or pink, normally they do not experience any soreness or pain.

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Rubella virus keeps alive in the victim's respiratory tract for anything between two to three weeks prior to the symptoms of the disease appear on the patient. In fact, the malady itself sustains for around five days, but any child contacting the illness is said to be contagious from around seven days before the appearance of the rash to five days after they have been healed completely. Therefore, in case you find your child developing German measles, you ought to contact everyone who has been exposed to him or her during the past one week. Remember, this is extremely essential as this disease may be very mild in children, but may have disastrous effects on pregnant women infected by the rubella virus. Hence, every effort needs to be made to keep off pregnant women or women who are planning to become pregnant soon from children who have endured German measles and the disease itself. In case a pregnant woman or one who is likely to be pregnant comes in contact with children who are affected by the virus or they somehow contact this seemingly innocuous illness, it may create havoc on the fetus - even result in significant birth defects.

An effective vaccine against rubella or German measles was not available till 1969 and before this the 'three-day measles' occurred as an epidemic once in every six to nine years. The majority of the victims of the ailment were children in the age group of five and nine years. In those days, instances of inherent German measles were not very uncommon. However, things have changed since the availability of the vaccine against rubella or inherited rubella.

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It is interesting to note that while the German measles or rubella usually infected children in earlier days, currently the virus mostly infects the young who have not been immunized against the disease. According to medical experts, presently around 10 per cent of the young adults or teenagers are at risk of developing German measles. This, they anticipate, might pose a great threat to children if they are infected by rubella virus sometime later.

Initially, the symptoms of infection caused by rubella virus may include a mild fever for a couple of days with body temperature ranging between 99°F to 100°F (37.2°C to 37.8°C). In addition, the patient may experience sore or sensitive lymph nodes caused by swelling - in most cases behind the neck or at the back of the ears. Subsequently, rashes appear on the face of the victim and they extend downwards. As the rash spreads downwards, the face becomes clear - the rash on the face begins to heal. In fact, in most cases, the rash is the first noticeable symptom of the disease.

It is important to note that the rash caused by rubella infection appears similar to the rashes caused by any other viral infection. They usually appear as pale reddish spots or pinkish, which may merge to give rise to uniformly colored patches. These rashes may cause itching and the patient may have to endure the uncomfortable feeling for as many as three days. When the rash begins to heal, sometimes the skin affected by them falls off in the form of very thin scales.

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In addition to the above mentioned symptoms, rubella infection may also cause loss of appetite, headaches, trivial conjunctivitis, such as, inflammation of the lining of the eyeballs and eyelids, swollen lymph nodes in different regions of the body, a congested or runny nose, pain and swelling of the joints. While most of these symptoms are visible among teenagers and adults, swelling of the joints especially occurs among young women. Nevertheless, it has been seen that several patients suffering from German measles do not have any of these symptoms or even, if they have, they are few in number and not all of them mentioned here.

As mentioned earlier, when pregnant women are affected by the rubella virus it may result in congenital rubella syndrome (rubella inherited from the mother) and may potentially cause ravaging effects on the fetus and causing birth defects among children. In fact, babies infected by rubella virus prior to their birth are at a risk of retardation in physical growth, mental impedance, and physical deformities, distortion of the eyes and the heart as well as problems of the bone marrow, liver and spleen.

Rubella virus is transmitted from one victim to another through the respiratory route. The disease is transmitted when people already suffering from the infection or who have not completely recovered from the ailment release infinitesimal droplets from their nose or the throat and they are inhaled by healthy persons. In fact, people who have already been infected by the virus are actually contagious during the period between one week prior to contacting rubella virus and a week after they have actually recovered from the ailment. Hence, such people should avoid contact with healthy persons, especially pregnant women or those who are planning to become pregnant shortly.

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Even newborns enduring congenital rubella syndrome or have inherited the disease from their mother before birth have the potential to release the virus through their urine. In addition, they may also discharge the virus from their nose and throat for a period of one or more years after their birth. Since this may affect people who have not been vaccinated against the disease, people should essentially avoid contact with such babies whose mothers have been infected by rubella virus during or before pregnancy.

Supplements and herbs

Goldenseal and Echinacea are two herbs that may help your child to combat a viral infection, including rubella or German measles. Both the herbs have the aptitude to invigorate or fortify the immune system and, hence, are effective in treating most viral infections. If you child has developed German measles, give him a liquid dosage of the blended formula prepared from these two herbs thrice every day for about a week.

Prevention

While there was no means to protect one from rubella infections till 1969, things changed for the good with the development of a new vaccine against the virus the same year. Since immunization is the only way to protect children as well as young adults from German measles, extensive immunization against this virus is vital to restrict the spread of this malady. Immunization will not only help people to keep off the rubella virus, but is also effectual in avoiding deformities owing to congenital rubella syndrome - a condition when a pregnant woman infects the fetus by passing on the virus through the blood supply.

Generally, this vaccine is administered to babies in the age group of 12 to 15 months and it forms a part of the immunization regimen that is known as measles-mumps-rubella (MMR) immunization. Children are again given a second dose of the immunization when they grow up. This second dose of vaccination is generally given to children when they are four to six years old. Like in the case of any other immunization schedule, in this instance too there are some significant exemptions and unusual conditions. The doctor treating your child will have all information regarding his/ her health conditions and is the best person to decide if any exceptional action needs to be taken vis-à-vis the vaccination against rubella.

It is important to note that pregnant women or those planning to become pregnant within a month should never be given the rubella vaccination. On the other hand, any woman who is planning to become pregnant should ensure that she is immune to the virus. In order to ascertain this, they need to undertake blood examinations or obtain any other evidence regarding their immunization against rubella. Women who are not immune to the virus should essentially take the vaccination no less than a month before becoming pregnant to avoid the risk of developing congenital rubella syndrome.

In fact, it is essential for all pregnant women to keep off from people who have been infected by rubella virus and have suffered German measles. In addition, such women should be vaccinated soon after childbirth with a view to immunize them from the viral attack whenever they become pregnant again in future.

Incubation

Rubella virus has an incubation period of 14 to 23 days. However, it usually lasts for around 16 to 18 days in most cases. In other words, this denotes that it takes approximately three weeks for a child to develop the disease after he/ she has come in contact with any person already infected by the virus. It takes another couple of days for the first symptom of the disease - rashes - to appear on the patient's body.

Duration

The initial symptoms of German measles, the rash on the face and other parts of the body, usually lasts for around three days. Hence, this disease is also known as the 'three-day measles'. The other symptoms of the illness, including swollen lymph nodes may persist for about a week or even more, while the patient may endure joint aches for more than two weeks. While children who are infected by rubella virus usually take a week's time to recover, in the case of adults the recovery time is even longer. However, it needs to be borne in mind that even after all the symptoms of the disease are gone and the patients has recovered from the illness, they remain contagious for another week and should not come in contact with healthy people during this period.

Treatment

Antibiotics are useless in treating rubella or German measles as they do not work against any viral infection. Generally, rubella heals by itself. However, if any complications arise during the course of the ailment, you need to seek medical help. However, if a pregnant woman comes in contact with any persons infected with rubella or have suffered German measles, she should immediately contact her gynecologist.

Children who have been infected by rubella or are suffering from German measles usually have trivial symptoms of the disease and may be treated at home. However, it is important to keep an eye on the child's body temperature during the ailment and if you find the temperature rising abnormally, seek immediate medical help.

If you find that the child is experiencing uneasiness due to German measles, you may give him ibuprofen or acetaminophen to alleviate his/ her conditions. However, never ever give aspirin to a child suffering from viral infections because the use of this medication is related with the development of a condition called Reye syndrome. Reye syndrome has the aptitude to result in the failure of the liver functioning and may even cause death.

Time for calling the doctor

Normally, German measles in children is a mild ailment and can be treated at home. However, you need to seek medical help if the child's temperature begins to rise fast. You should immediately call a doctor if you find that the child's fever has a temperature of 102°F (38.9°C) or more. If the child is below the age of six months, call the doctor if you find the temperature rising to 100.4°F (38°C) or more. You should also seek immediate medical aid if you notice that your child is getting sicker by the day due to rubella or has developed symptoms that are no longer mild (as described earlier).

As mentioned earlier, rubella or German measles is supposed to be a very mild ailment, but it may prove to be disastrous when pregnant women or women planning to become pregnant soon are infected by the virus. When pregnant women are affected by rubella virus, it may result in numerous problems and the disease may also induce abortion or miscarriage. When the fetus of the pregnant women infected by the virus is also affected by rubella, it may result in congenital rubella syndrome of CRS. In fact, congenital rubella syndrome leads to numerous birth deformities in the baby. Some of the conditions that a baby/ fetus may endure owing to congenital rubella syndrome are as follows:

  • Microcephaly (born with a relatively smaller head);
  • Limited development of the fetus during pregnancy;
  • Aberration of the heart;
  • Hearing impairment;
  • Cataracts and other eye deformities;
  • Born with damaged brain, bone marrow, liver and lungs.

What needs to be done if you are not immunized against rubella?

The immunity against rubella is likely to change over a period of time. Hence, women planning to become pregnant need to get their immunity against the virus examined before they start trying to conceive. This is important even if a woman has been vaccinated against rubella in the past. To check your immunization against rubella, one may ask their doctor or even a practicing nurse to undertake a blood test.

On the other hand, if you are aware that you are not immune to rubella infection, it is essential to get vaccinated against the virus at least one month before you become pregnant. In other words, you need to start trying for a baby only after a month from the date of the vaccination. This period provides a woman with sufficient time to eliminate the virus from her body, in case she has been infected by it unknowingly, and avoids the risks of congenital rubella syndrome (CRS). Your baby will be safe from the viral infection if you follow these crucial guidelines.

In case the blood tests performed during the early phase of pregnancy show that the woman does not have any immunization from rubella, she would be required to wait till delivering the baby and then take the vaccination against the virus. In such cases, the concerned woman may be vaccinated prior to being released by the hospital if the childbirth has taken place in a hospital. Alternately, if the delivery has been done elsewhere, she needs to be vaccinated during the check-up six weeks in the postnatal period.

Do not panic even if you have been vaccinated against rubella in the initial weeks of your pregnancy when you were unaware of the fact that you have already conceived. In fact, so far there have been no complaints of congenital rubella syndrome developing in infants in such situations. In such cases, your GP or midwife will suggest that you undergo an ultrasound test around the time when you are 18 to 20 weeks in pregnancy with a view to closely observe your baby and its development in the womb. Optimistically, they would also provide you with some comfort when everything is normal.

What are the risks if one develops German measles or rubella during pregnancy?

The possibilities of your baby becoming a victim of congenital rubella syndrome entirely depend on the stage of pregnancy when you are infected by the virus. In fact, the risks of your baby also being affected by German measles are the maximum if you are infected by the virus during the 11th week of your pregnancy. In fact, it has been found that around 9 out of 10 infants are affected by this viral disease if their mother catches the disease during this period of their pregnancy. The chances of your baby developing rubella is almost nil or rare if you are infected by the virus during your 17th week of pregnancy or later. However, the baby may still be affected by deafness even if you catch the viral infection as late as the 20th week of pregnancy.

Therefore, if you are doubtful regarding your immunity against rubella you need to avoid coming in contact with any person who may have been affected by rubella virus or had already endured the disease. This is especially true during the first few weeks of your pregnancy. This will help to avoid congenital rubella syndrome (CRS).

However, it is really unfortunate that if you happen to develop German measles or rubella while you are pregnant, especially within 17 months of your pregnancy, there is little or nothing that can be done to protect your fetus/ unborn baby from developing congenital rubella syndrome, which may actually result in various birth defects in the baby. Precisely speaking, till date there is no medication that is effective in preventing the devastation caused to fetus if pregnant women catch the disease. The only thing that may be done is to conduct blood tests to find out if you have actually been infected by the virus while you are pregnant. In such circumstances, your gynecologist or even the midwife may recommend certain tests to ascertain if your fetus has already been harmed. And, in case it is detected that the fetus has been damaged because of you contracting the virus during pregnancy, you may be advised to terminate your pregnancy. While this is traumatizing indeed, there is no other option, but to induce an abortion. This will help to prevent the birth of a baby with numerous deformities.

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